RDMS Application

RDMS Application
While at our campus, you will be provided with room and board. You will be sent a list of items you may bring when you come.

We will contact you soon with further questions and instructions as well as a time for a phone interview.

Thank you for praying about this diligently, seeking counsel, and allowing us this chance to work with you for one of the greatest adventures of Christian living! Seeing men and women delivered from their addictions and becoming true disciples of the Gospel of Jesus Christ.

Note: This form contains multiple sections and will take some time to fill out. You can save an unfinished form to your browser - and continue on the same browser later - using the "save" button at the bottom of each section.

However, We suggest collecting any necessary information beforehand, and filling out and submitting the form in a single session.

There are 5 pages (or sections), once you complete one - click the "next" button at the bottom of the page to continue to the next section.
Your information

Let's start with some of your information.
Name*

First NameMiddle NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Separate Mailing/Physical Address*
Do you live somewhere different from where you receive mail?
Email*
example@example.com
Physical Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Picture*

Upload an image of yourself for reference.
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List your public social media links:*
Tell us your personal testimony:*

Church Information

Give us some information about the church you're involved with.
Church Name*
Church Phone Number*
Please enter a valid phone number.
Church Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Senior Pastor*
Pastor/Leader you work with*

Ministry Experience

Tell us about your work/ministry experience.
Tell us about any ministries you are currently involved in, and any you've been involved with in the past.*
You can upload an optional ministry resume in .pdf or .docx format below (Not required)
(Optional) Ministry Resume

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Educational History

Include high school and college history.
List any high schools diplomas, college diplomas, or training/certifications you've received. Include graduation dates.*

References

We need contact information for a pastor, an employer, and an acquaintance.
Pastor

Should be your head pastor, or a pastor you work directly with.
Pastor's Name*

First NameLast Name
Pastor's Email*
example@example.com
Pastor's Phone Number*
Please enter a valid phone number.
Church Name*
Pastor's Position*
Ex. Head Pastor, Associate Pastor, ETC.
Employer

Should be your employer. If you work in a corporate environment where you can't access the owner of the business, list your manager/department lead.
Company Name*
Reference's Position*
Ex. Owner, Department Lead, Production Manager, ETC.
Employer Name*

First NameLast Name
Employer's Email*
example@example.com
Employer's Phone Number*
Please enter a valid phone number.
An Acquaintance

This should be someone who only knows you "from a distance", and isn't a direct friend or family member.
Acquaintance Name*

First NameLast Name
Acquaintance Email*
example@example.com
Acquaintance Phone Number*
Please enter a valid phone number.
Tell us how this person knows you:*
Should be Empty:

RDMS Application

Your information

Church Information

Ministry Experience

Educational History

References

Pastor

Employer

An Acquaintance